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It’s a rite of passage for kids: A fresh, colorful new backpack to start off the school year. While there’s no doubt that using a backpack makes carrying books easier, there’s some debate about whether a heavy backpack is harmful to a child’s health, potentially causing chronic back pain or back injuries.

Is your child’s backpack posing a health risk? Here’s what you need to know about backpacks and chronic back pain and what to do to ensure your child’s health.

Backpacks and Back Pain: The Potential Link

In 2013 alone, the U.S. Consumer Product Safety Commission cited 5,415 backpack-related injuries treated at emergency rooms. In light of stats like these, some experts point to the dangers of heavy backpacks, noting injuries ranging from acute back pain to chronic back pain to other types of damage.

“Wearing a backpack incorrectly or wearing one that's too heavy can be a contributing risk factor for discomfort, fatigue, muscle soreness, and pain, especially in the lower back,” says Karen Jacobs, EdD, OTR/L, CPE, a clinical professor of occupational therapy at Boston University and an expert on school ergonomics and healthy growth and development of school-age children.

Neck and shoulder pain can also stem from carrying a heavy backpack, says Samantha Dutrow, PT, DPT, CSCS, a physical therapist at Lucile Packard Children’s Hospital Stanford in Palo Alto, Calif. “Injury can occur when a child is trying to adapt to the heavy load by using improper postures, such as leaning forward, arching the back, and leaning to one side.”

But studies have also shown conflicting results. Eric J. Wall, MD, director of orthopedic sports medicine at Cincinnati Children’s Hospital and a professor in the University of Cincinnati’s department of surgery, led early research on backpack injuries in children. In his study, published in 2003, only one of 346 students noted that back pain was related to wearing a backpack.

“We expected to find a lot more problems,” Dr. Wall says. “However, it seemed like backpacks weren’t causing an epidemic of back pain.”

What’s more, a study published in the May 2013 issue of the Journal of School Health found that the causes of back pain in children are difficult to link to backpack use, and that much of the existing research is inconclusive. The researchers also noted that no study has examined the long-term effects of heavy backpacks.

Backpack Basics: 5 Ways to Ease the Load

While the jury is still out on whether heavy backpacks lead to chronic back pain, the potential risk is there, so it’s important to take precautions to ensure your child’s health. To minimize backpack-induced discomfort and pain that may create a bigger health problem, follow these backpack buying (and wearing) tips:

Skip rolling backpacks. Most schools have flights of stairs, which requires lifting and carrying rolling backpacks up the stairs. “Lifting the backpack to climb the stairs is going to be problematic for your child’s back,” Wall says.

Look for structure. Many quality-made backpacks come with a padded back and a plastic frame sheet, which helps add structure and rigidity. “This can help distribute the weight of the load,” Wall says.

Watch the weight. “The weight of the backpack should be 10 to 15 percent of the child’s body weight or less,” Dutrow says. “The heaviest items should be placed closest to the child’s back in the backpack.”

Make a two-strap rule. Opt for a backpack with wide, padded straps so your child can comfortably bear the weight of all the books. Avoid backpacks with a narrow string that might dig into the skin. Keep straps snug so the backpack fits right against the child’s back. Also, make sure your child actually wears the backpack with both straps over the shoulders so the weight is evenly distributed.

Make sure your child is using the backpack correctly. Wall believes that most backpack-related injuries can be attributed to improper use, including tripping over backpacks, injuries to the face from kids swinging packs around, and shoulder injuries from improperly lifting heavy backpacks. Talk to your child about dos and don’ts of basic backpack use.

Wall stresses that it's important to invest in a high-quality backpack to help your child bear the load more comfortably. “If kids are complaining about pain from backpacks, get them a better one,” he says. By helping relieve the extra strain, the right backpack can help your child start every morning comfortably and pressure-free, paving the way for a successful new school year.

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